FATAL ERRORS

May 18, 2005

As many as 98,000 Americans still die each year because of medical errors despite an unprecedented focus on patient safety over the last five years, according to a study published in the Journal of the American Medical Association.

Significant improvements have been made in some hospitals since the Institute of Medicine released a landmark report in 2000 that revealed many thousands of Americans die each year because of medical mistakes.

Since then, some hospitals have taken steps that can reduce medical errors and injuries. For example:

Computerized prescriptions can reduce errors due to misreading medication instructions by 81 percent.

Including a pharmacist in a medical team can prevent 78 percent of adverse drug reactions.

Team training in delivering babies can decrease harmful outcomes -- such as brain damage -- in premature deliveries by 50 percent .

But nationwide, the pace of change is painstakingly slow, and the death rate has not changed much, according to the researchers.

They blame the complexity of health care systems, a lack of leadership, the reluctance of doctors to admit errors and an insurance reimbursement system that rewards errors --hospitals can bill for additional services needed when patients are injured by mistakes --but often will not pay for practices that reduce those errors.

For example, 5 to 8 percent of intensive-care patients on ventilators develop pneumonia. But by strictly following a simple protocol of bed elevation, drugs and periodic breathing breaks, those outbreaks can be reduced to almost zero.

Hospitals that eliminate infections should receive bonuses, coauthor Lucian Leape (Harvard's School of Public Health) says. "If insurance companies paid 20 percent more for patients in (intensive-care units) where there were no infections, they'd cut costs substantially. We really need to rethink how we pay for health care. What we do now is pay for services, but what we should do is pay for care and outcomes."

Source: Elizabeth Weise, "Medical errors still claiming many lives," USA Today, May 18, 2005; based upon Lucian L. Leape and Donald M. Berwick, "Five Years After 'To Err Is Human': What Have We Learned?" Journal of the American Medical Association, May 18, 2005.